California Code of Regulations
Title 10 - Investment
Chapter 5.8 - Managed Risk Medical Insurance Board Healthy Families Program
Article 3 - Health, Dental and Vision Benefits
Section 2699.6725 - Share of Cost for Vision Benefits
Current through Register 2024 Notice Reg. No. 12, March 22, 2024
(a) A participating vision plan shall require copayments for benefits provided to subscribers utilizing the services of the vision plan's panel of approved providers subject to the following except that subscribers with household income at or below 150% of the Federal Poverty Level shall pay a $5 copayment when a copayment is required:
A frame allowance of $35 is provided by the vision plan. The subscriber is responsible for any costs exceeding this allowance. The participating vision plan shall ensure that a selection of frames that do not cost more than the frame allowance is available to all subscribers.
The following options are considered cosmetic and any costs associated with the selection of these options will be the financial responsibility of the applicant.
(b) Services from providers not included in the vision plan's panel of approved providers:
When a subscriber obtains services from a provider not included in the vision plan's panel of approved providers, the applicant will be responsible for paying the provider for all services and materials received at the time of their appointment. The participating vision plan will reimburse the applicant within fourteen (14) calendar days after receipt of the paid itemized bill or statement, according to the schedule of allowances as follows:
(c) No deductibles shall be charged to subscribers for vision benefits.
(d) For subscriber parents who receive vision services from one of the participating member doctors, covered services as described are provided with no additional out-of-pocket costs after an applicable copayment. Additional services selected for cosmetic purposes are the financial responsibility of the patient.
(e) No copayments shall apply if the applicant has submitted acceptable documentation as described in Section 2699.6600(c)(1)(GG) that the applicant or the subscriber is American Indian or Alaska Native. However, there is no limitation on the payments required under Subsection (b) above.
1. Renumbering
of former section
2699.6721 to section
2699.6725, including amendment of
section and NOTE, filed 4-29-2002 as an emergency; operative 4-29-2002
(Register 2002, No. 18). Pursuant to Chapter 946, Statutes of 2000, section
2, a Certificate of Compliance
must be transmitted to OAL by 10-28-2002 or emergency language will be repealed
by operation of law on the following day.
2. Certificate of
Compliance as to 4-29-2002 order transmitted to OAL 10-28-2002 and filed
12-12-2002 (Register 2002, No. 50).
3. Amendment of subsection (e)
filed 7-31-2003 as an emergency; operative 7-31-2003 (Register 2003, No. 31). A
Certificate of Compliance must be transmitted to OAL by 1-27-2004 or emergency
language will be repealed by operation of law on the following
day.
4. Certificate of Compliance as to 7-31-2003 order transmitted
to OAL 11-17-2003 and filed 12-30-2003 (Register 2004, No. 1).
5.
Amendment of subsection (e) filed 7-1-2004 as an emergency; operative 7-1-2004
(Register 2004, No. 27). Pursuant to Section
80, A.B. 1762 (Chapter 230, Stats.
2003) a Certificate of Compliance must be transmitted to OAL by 12-28-2004 or
emergency language will be repealed by operation of law on the following
day.
6. Certificate of Compliance as to 7-1-2004 order transmitted
to OAL 11-24-2004 and filed 1-7-2005 (Register 2005, No. 1).
7.
Amendment filed 9-15-2008; operative 10-15-2008 (Register 2008, No.
38).
8. Amendment of subsections (a)(2) and (b)(2)(F) filed
1-15-2009, deemed an emergency pursuant to Chapter 758, Statutes of 2008;
operative 1-15-2009 (Register 2009, No. 3). A Certificate of Compliance must be
transmitted to OAL by 7-14-2009 or emergency language will be repealed by
operation of law on the following day.
9. Certificate of Compliance
as to 1-15-2009 order transmitted to OAL 7-13-2009 and filed 8-19-2009
(Register 2009, No. 34).
10. Amendment of subsections (a)-(a)(2) and
(a)(5)(B) and amendment of NOTE filed 10-29-2009; operative 11-1-2009 pursuant
to Government Code section
11346.1(d)
(Register 2009, No. 44). A Certificate of Compliance must be transmitted to OAL
by 4-30-2010 or emergency action will be repealed by operation of law on the
following day. This regulatory action is deemed to meet the emergency standard
and is exempt from OAL review pursuant to Insurance Code section
12693.22.
11.
Certificate of Compliance as to 10-29-2009 order transmitted to OAL 4-27-2010
and filed 6-9-2010 (Register 2010, No. 24).
12. Amendment of
subsections (a)(2), (a)(4), (b)(2)(A)-(E) and (b)(2)(I) and amendment of NOTE
filed 6-30-2011, deemed an emergency pursuant to Insurance Code section
12693.22;
operative 6-30-2011 (Register 2011, No. 26). A Certificate of Compliance must
be transmitted to OAL by 12-27-2011 or the emergency action will be repealed by
operation of law on the following day.
13. Certificate of Compliance
as to 6-30-2011 order transmitted to OAL 12-20-2011 and filed 2-3-2012
(Register 2012, No. 5).
Note: Authority cited: Sections 12693.21, 12693.22, 12693.62 and 12693.755, Insurance Code. Reference: Sections 12693.21, 12693.22, 12693.62, 12693.65 and 12693.755, Insurance Code.